Provider Demographics
NPI:1083686257
Name:GORDON, MARK ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ERNEST
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9411 N OAK TRFY
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-436-7072
Mailing Address - Fax:816-436-2743
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3251
Practice Address - Country:US
Practice Address - Phone:816-421-4240
Practice Address - Fax:816-421-5015
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR1D12207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10000045OtherBCBS OF KC INDIVIDUAL
MO201851839Medicaid
110086289OtherRAILROAD MEDICARE
10000045OtherBCBS OF KC INDIVIDUAL
C50543Medicare UPIN